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I J C R I I n t e r n a t i o n a l J o u r n a l o f C a s e R e p o r t s a n d I m a g e s , V o l . N o . 2 0 1 3 . I S S N [ 0 9 7 6 - 3 1 9 8 ]

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Lesser-trlat sign in a patient with neoplasia of upper

eye lidSatyaki Ganguly, Kranti C Jaykar, Sambeet Kumar Mallik

Disclaimer: This manuscript has been accepted forpublication in International Journal of Case Reports and

Images (IJCRI). This is a pdf file of the provisionalversion of the manuscript. The manuscript will under gocontent check, copyediting/proofreading and contentformating to conform to journal's requirements. Pleasenote that during the above publication processes errorsin content or presentation may be discovered which will

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version.

CASE REPORT

A 40-year-old lady presented to the DermatologyOPD with an ulcerating growth of the left upper eye-lidfor the last three years. The growth was graduallyincreasing in size. On examination, there was anirregular erythematous swelling involving the whole ofleft upper eye-lid with ulceration and areas of necrosisin the lateral part. A provisional diagnosis of sebaceous

C L I N I C A L I M A G E S O P E N A C C E S S

S a t y a k i G a n g u l y

1

, K r a n t i C J a y k a r

2

, S a m b e e t K u m a r

M a l l i k

3

A f f i l i a t i o n s :

1

A s s i s t a n t P r o f e s s o r , D e p t o f D e r m a t o l o g y ,

V e n e r e o l o g y a n d L e p r o s y P o n d i c h e r r y I n s t i t u t e o f

M e d i c a l s c i e n c e s , P o n d i c h e r r y ;

2

A s s i s t a n t P r o f e s s o r , D e p t

o f D e r m a t o l o g y , V e n e r e o l o g y a n d L e p r o s y K a t i h a r M e d i c a l

C o l l e g e , K a t i h a r , B i h a r ;

3

J u n i o r r e s i d e n t , D e p t o f

D e r m a t o l o g y , V e n e r e o l o g y a n d L e p r o s y K a t i h a r M e d i c a l

C o l l e g e , K a t i h a r , B i h a r .

C o r r e s p o n d i n g A u t h o r : D r . S a t y a k i G a n g u l y , D e p t o f

D e r m a t o l o g y , V e n e r e o l o g y a n d L e p r o s y P o n d i c h e r r y

I n s t i t u t e o f M e d i c a l s c i e n c e s , P o n d i c h e r r y - 6 0 5 0 1 4 ; E m a i l :

s a t y a k i g a n g u l y @ y a h o o . c o . i n

R e c e i v e d : 1 9 N o v e m b e r 2 0 1 1

A c c e p t e d : 1 3 A p r i l 2 0 1 2

P u b l i s h e d : 0 1 J a n u a r y 2 0 1 3

G a n g u l y e t a l . 1

gland carcinoma was made. A biopsy of the eyelidgrowth was advised to confirm the diagnosis. Along witheyelid lesion, numerous asymptomatic darkly pigmentedpapules were discovered over the face, trunk andextremities, more over the flexures like the neck, axilla,sub-mammary area and groin (Figure 1, 2). On being

questioned about the lesions, the patient said that theselesions have appeared rapidly over a period of last sixmonths. Detailed haematological, biochemicalinvestigations, chest X-ray, upper GI endoscopy, lowerGI endoscopy, mammography, abdominal ultrasoundand bone marrow examination failed to reveal anyevidence of any systemic malignancy. Based on theclinical findings a diagnosis of Lesser-Trlat sign inassociation with skin malignancy was made. The patient

was referred to ophthalmology department for furthermanagement of the growth in the eyelid. Unfortunately,

before a biopsy could be done the patient was lost tofollow-up.

Figure 1: Lesser-Trlat sign: Upper eyelid tumour withnumerous seborrheic keratoses over face and neck.

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DISCUSSION

Seborrhoeic keratoesis is a benign tumour,frequently pigmented, more common in elderly andcomposed of epidermal keratinocytes. The suddenappearance of numerous seborrhoeic keratoses in anadult may be a cutaneous finding of internalmalignancy. Internal malignancy associated with thesudden development of numerous seborrhoeic keratosesin an eruptive fashion, with or without pruritus, isknown as the sign of Lesser-Trlat [1]. Weakened

subepithelial matrix from the effects of neoplasm on theextracellular matrix of the host has been postulated as apossible cause of lesser Trlat sign.

Common malignancies associated with this sign areadenocarcinoma of stomach (most common), lung,colon, breast, prostate, lymphoma, leukemia, ovariancancer, nasopharyngeal carcinoma and transitional cellcarcinoma of bladder [2]. It has been associated withskin malignancies like maligna melanoma [3],lymphocytoma cutis [4] Pagets disease [5] and Sezarysyndrome [6]. A sudden eruption of many seborrhoeickeratoses may follow exfoliative erythroderma,erthrodermic psoriasis, erythrodermic drug eruption,

lepromatous leprosy and HIV infection [7]. Sebaceousgland carcinomas are very rare tumors, usually arisesfrom the meibomian glands and majority of lesions

Figure 2: Lesser-Trlat sign: Upper eyelid tumour withnumerous seborrheic keratoses over axilla.

affect the upper eye lid. The lesions are nodular andappear like a chalazion which lasts for more than sixmonths.

CONCLUSION

To be considered a case of Lesser-Trlat, thekeratoses should begin at approximately the same timeas the development of cancer and run a parallel coursein regard to growth and remission.

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Ganguly S, Jaykar KC, Mallik SK. Lesser-trlat sign in apatient with neoplasia of upper eye lid. InternationalJournal of Case Reports and Images 2013 ():*****.

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doi:10.5348/ijcri-2013-01-266-CI-20

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Author ContributionsSatyaki Ganguly Substantial contributions toconception and design, Acquisition of data, Drafting thearticle, Revising it critically for important intellectualcontent, Final approval of the version to be published

Kranti C Jaykar Substantial contributions to analysisand interpretation of data, Drafting the article, Finalapproval of the version to be publishedSambeet Kumar Mallik Substantial contributions toacquisition of data, Drafting the article, Final approvalof the version to be published

GuarantorThe corresponding author is the guarantor ofsubmission.

Conflict of InterestAuthors declare no conflict of interest.

Copyright Satyaki Ganguly et al. 2013 This article is distributedunder the terms of Creative Commons Attribution 3.0License which permits unrestricted use, distributionand reproduction in any means provided the originalauthors and original publisher are properly credited.(Please see www.ijcasereportsandimages.com/copyright-policy.php for more information.)

REFERENCES

1. Sneddon IB, Roberts BM. An incomplete form ofacanthosis nigricans. J Br Soc Gastroent 19623:269-272.

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2. Schwartz RA. Sign of Lesser-Trlat. J Am AcadDermatol 1996 Jul 35(1):88-95.

3. Fanti PA, Metri M, Patrizi A. The sign of Leser-Trlat associated with malignant melanoma. Cutis1989 Jul 44(1):39-41.

4. Halevy S, Sandbank M. Transformation oflymphocytoma cutis into a malignant lymphoma in

association with the sign of Leser-Trlat. Acta DermVenereol 1987 67(2):172-5.

5. Shamsadini S, Wadji MB, Shamsadini A.Surrounding ipsilateral eruptive seborrheickeratosis as a warning sign of intraductal breastcarcinoma and Paget's disease (Leser Trelat sign).Dermatol Online J 2006 Oct 3112(6):27.

6. Ikari Y, Ohkura M, Morita M, Seki K, Kubota Y,Mizoguchi M. Leser-Trlat sign associated withSzary syndrome. J Dermatol. 1995 Jan 22(1):62-7.

7. Flugman SL, McClain SA, Clark RA. Transienteruptive seborrheic keratoses associated witherythrodermic psoriasis and erythrodermic drugeruption: report of two cases. . J Am AccadDermatol. 2001 Dec 45(6 Suppl):212-4.

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